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DGH v Tertiary Intervention – Is there really a conflict ?. Steven Lindsay Bradford Teaching Hospitals NHS Trust. Conflict of Interest I am a “DGH” interventionalist. Bradford. History lesson. Cardiology in Bradford in 1999. 1000 bedded DGH 400,000 population

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dgh v tertiary intervention is there really a conflict

DGH v Tertiary Intervention – Is there really a conflict?

Steven LindsayBradford Teaching Hospitals NHS Trust

slide2

Conflict of Interest

I am a “DGH” interventionalist

cardiology in bradford in 1999
Cardiology in Bradford in 1999
  • 1000 bedded DGH
  • 400,000 population
  • 2 cardiologists -non interventional
  • 2 diagnostic angio sessions in multipurpose lab
cardiac labs in west yorkshire 1999
Cardiac Labs in West Yorkshire 1999
  • 9 DGH labs – most multi purpose
  • All PCI in Leeds (3 cardiac labs open)
  • 4 Tertiary Centre Interventionalists
  • 7 DGH visitors
cardiology in bradford in 2000
Cardiology in Bradford in 2000
  • 1000 bedded DGH
  • 400,000 population
  • 3 cardiologists -1 interventional
  • 2 diagnostic angio sessions in multipurpose lab
  • 1 diagnostic session in Airedale
  • 1 PCI session in tertiary centre
cardiology in bradford in 2001
Cardiology in Bradford in 2001
  • 1000 bedded Teaching Hospital
  • 400,000 population
  • 3 cardiologists -1 interventional
  • 2 diagnostic angio sessions in multipurpose lab
  • 1 diagnostic session in Airedale
  • 1 PCI session in tertiary centre
  • 9 month waiting list for PCI
cardiology in bradford in 2002
Cardiology in Bradford in 2002
  • 1000 bedded Teaching Hospital
  • 400,000 population
  • 3 cardiologists -1 interventional
  • 1 Associate Specialist
  • Dedicated cardiac lab
  • 2nd Interventional post approved
  • 2 PCI session in tertiary centre
pci in west yorkshire 2002
PCI in West Yorkshire 2002
  • 2002/2003 total PCI activity in Leeds 1691 cases
  • NSF targets of 750 pmp by 2004/2005= 2380 cases
  • Airedale PCI activity corrected for SMR is 1157 pmp (equivalent to 5000 PCIs p.a. across the WYNCC).
  • But where is the extra capacity?
bradford
Bradford
  • NSF targets = 370 cases pa for the 3 Bradford PCTs.
  • The Bradford “patch” is sufficiently large to support a stand-alone PCI service and more than satisfy the BCIS requirements for a minimum of 200 cases p.a. and individual operator caseloads of at least 75 cases p.a.
  • 3 vacant lab sessions are available for PCI.
  • 3 cases per session and working year of 40 weeks = 360 cases p.a.
  • Retain one session for “high risk” cases and adjunctive technologies (IVUS, rotablator, presssure wire)
  • Release one session in Leeds -a further 120 cases can be carried out.
  • Network capacity increased by 480 cases
what we actually did
What we actually did
  • Jan 05 started with 1 acute session in Bradford
  • April 2005 1 elective session in Bradford
  • All Bradford PCI sessions in am
  • Not a 24/7 service
  • Out of Hours cover from Leeds (never utilised)
  • May 2006 Bradford Interventionalists occupy 1 slot on W York\'s PPCI rota in Leeds
bradford interventional activity 2005 2007
Bradford Interventional activity 2005-2007
  • 453 at LGI Jan 05 to Jan 07
  • 349 at BRI Jan 05 to Jan 07
  • 2 operators
    • 3 lists/wk at BRI
    • Ad hoc acute activity during working week
    • 2 lists/wk (1 all day list) at LGI
thankyou
Thankyou
  • West Yorkshire Network
  • Jim McLenachan and Stacey Hunter LTHT
  • Chris Durkin BTHT
  • John Kurian BTHT
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